Potential risk of cross-infection by tourniquets: a need for effective control practices in Pakistan

Tourniquets used repeatedly on patients for blood sampling are a potential source of nosocomial infections. They harbor numerous microorganisms, including methicillin-resistant Stapbylocoecus aureus [MRSA]. The aim of this study was to investigate tourniquets for the presence of microorganisms and to ascertain the infection control practices of health care workers. A cross-sectional study was carried out in 2012 on 100 samples of tourniquets collected from public and private sector hospitals in Karachi, Pakistan. The samples were cultured, and pathogenic microorganisms were identified and tested for methicillin resistance. A questionnaire was administered simultaneously to 100 health care workers who had used the tourniquets. Descriptive data are represented as frequencies and percentages. Ethical considerations were taken into account. The total colonization rate was 51%, with no bacterial growth in 17/40 and 32/60 samples from public and private sector hospitals, respectively. S. aureus was isolated from 12 [42%] private sector hospital samples and 10 [43%] public sector hospital samples. Although MRSA was found in more samples from public than private sector hospitals, the difference was not statistically significant. Nevertheless, 90% of all elastic and 41% of all rubber tourniquets harbored microorganisms [P < 0.001]. Although 96% of health care workers agreed that hospital staff and fomites can transmit infection, none identified tourniquets as a potential source. When asked whether tourniquets appeared clean before use, 66% agreed, and only 25% considered that tourniquets should be washed or cleaned before use. Tourniquets are a potential reservoir and vehicle for the spread of nosocomial infections, including MRSA. Health care workers have inadequate knowledge about infection control procedures and personal hygiene for disinfecting reusable items

Prisoners in Karachi – a health and nutritional perspective

The aim of this study was to assess the health and nutritional status of prisoners in Karachi, Pakistan. This cross sectional study was conducted from September 2012 to February 2013. Convenient sampling technique was used. A sample of 433 prisoners was taken from Karachi prison. Selected inmates were interviewed using a structured questionnaire. Prisoners were assessed with measurements of height, weight, body mass index [BMI] status, Blood pressure, Random Blood Sugar levels, dietary pattern, occupational status, source of food, duration of exercise, history of diseases and addictions were recorded. Age of the prisoners varied between 18-65 years. Among 433 prisoners, 39.7% were under weight and 8.3% were malnourished. Exercise was not reported in 80% of prisoners. It was noted that 11.8% prisoners were having respiratory tract infections at time the study was conducted. Among 433 inmates, 386 were addicted to at least one addiction such as smoking, naswar, pan, gutka and manpuri, heroin, ganja [cannabis], charas [hashish form of cannabis], and opium. This study showed that the diet of the prisoners was insufficient and nutritionally imbalanced and has led to malnourished and underweight prisoners. Substance abuse is common among inmates

Depression in cancer patients attending outpatients department of tertiary care hospitals of Karachi

To find out the frequency of depression and associated socio demographic factors in cancer patients of Karachi. A descriptive cross sectional study was conducted during July-August 2013. Through convenient sampling method, one hundred diagnosed cancer patients were selected from outpatient department [OPD] of a private and a public sector teaching hospital. Patients of both gender, 18 years of age and above and who were diagnosed with cancer at least one month before the interview were included. Depression was assessed by Patient Health Questionnaire [PHQ-9]. The questionnaire includes all nine criteria for diagnosis of cancer as described by Diagnostic and Statisical Manual of Mental Disorders IV [DSM-IV]. Data was analyzed by SPSS version 20. Chi square test was applied for categorical data at a significance level of p<.05. Mean age of participants was 45.46 +/- 13.8 SD years [range: 18 - 85 years]. Fifty three percent were males; Seventy eight percent were currently married. Mean income was 13262 +/- 9107 SD Pakistani rupees [range: 4500 - 45,000 Rs]. Seventy four percent patients were permanent residents of Karachi. In females breast cancer while in males oral cavity cancer were the leading type of cancers. Sixty five percent patients had current depression ranging from mild to severe. Seventy percent patients had financial problems in terms of treatment cost. Chemotherapy, fatigue and financial problems were positively associated with depression [p<0.05]. Frequency of depression in cancer patients is very high. Majority of the patients were married and had financial constraints in terms of treatment cost

Extremes of hyper and hypotensions in pheochromocytoma-a perioperative management

We report a case of 30 years old female who presented with history of frequent headaches, palpitation, sweating along with mass abdomen. Hypertension was accelerated as ECG reflected sinus rhythm with left ventricular hypertrophy and no papilloedema. Ultrasound abdomen revealed right sided, well defined solid mass posterolateral to the inferior vena cava. Urine analysis revealed raised metabolite vanillylmandalic acid. Patient was diagnosed as a case of pheochrojnocytoma of the right suprarenal gland. After control of blood pressure, laparotomy under general anaesthesia was performed. A big tumour was excised. Histopathology confirmed the diagnosis of pheochromocytoma

Management of vesicovaginal fistulae in urological context

To find out the commonest cause of vesicovaginal fistula [VVF] and describe the surgical management. A descriptive study. The Department of Urology and Transplantation, Pakistan Institute of Medical Sciences [P.I.M.S.] Islamabad, from January 1995 to April 2002. The subjects were presenting with vesicovaginal fistulae. Symptomatology and demographic causes were noted. Investigation included IVU, cystoscopy, vaginoscopy and examination under anesthesia. Repair and outcome was noted. Patients presented with genitourinary fistulae other than VVF were excluded from the study. Most of the patients were young women of childbearing age. The causative factor of VVF in 27 [84.3%] out of 32[100%] patients was obstetrical trauma. Surgical repair proved to be successful through transabdominal route in all 24 [100%] cases of VVF and in 4 [80%] out of 5 [100%] cases through transvaginal route. Repair failed in the 2[100%] attempted through abdominovaginal route and 1[100%] through endoscopic fulguration. To describe an overall result, 28 [87.5%] vesicovaginal fistulae were successfully repaired at first attempt. Obstetrical trauma was the commonest cause of VVF in this series. Transabdominal repair was the most successful method of repair in this series. Despite the good results of surgical repair, attempt should be focused on the prevention of VVF

TIVA and conventional general anaesthesia in elective C-section: comparative effects on the neonate

A comparative study was carried out on 70 patients, admitted at MH Rawalpindi from January 2003 to April 2003. The object of the study was to compare the effects on the new born of TIVA [total intravenous anaesthesia] using IV Propofol and conventional general anaesthesia. The selection criteria included, pregnant patients of ASA class I aged between 20 and 30 years, undergoing elective caesarean section, having no fetal abnormalities on antenatal ultra sound and incision to delivery time less than 5 minutes. The apgar score of the new born delivered was measured at first minute and fifth minute after birth and it was seen that the average apgar score of the group delivered by TIVA using IV Propofol was 9.63 the other group delivered by using conventional general anesthesia was 7.94. However as the Apgar score is highly subjective, so it was supplemented by observing various neurobehavioral reflexes. This also proved that the newborn babies delivered by TIVA using IV Propofol had higher Neurobehavioral scores as compared to newborns delivered using conventional general anaesthesia